Dumont Colin, Iesari Samuele, Baldin Pamela, Aydin Selda, Henin Guillaume, Philippart Marie, Bonaccorsi-Riani Eliano, Ciccarelli Olga, Coubeau Laurent, Piessevaux Hubert, Lanthier Nicolas, Dahlqvist Géraldine
Hepato-Gastroenterology Department, University Hospital Saint-Luc, Brussels, Belgium.
General Surgery and Kidney Transplantation, Foundation "IRCCS Ca' Granda Ospedale Maggiore Policlinico", Milan, Italy.
Transl Gastroenterol Hepatol. 2025 Jun 26;10:51. doi: 10.21037/tgh-24-131. eCollection 2025.
Graft steatosis and fibrosis detection is a challenge to avoid graft loss. The role of liver biopsy (LB) after liver transplantation (LT) is changing with the emergence of non-invasive tests. Our aim is to evaluate the accuracy of transient elastography (TE) in predicting steatosis and fibrosis post-LT.
This prospective study was performed on 158 LT patients. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were carried out prior to LB. We built receiver operating characteristic (ROC) curves to evaluate the predictive performance of TE.
Using CAP, the area under the curve (AUC) were 0.872 [95% confidence interval (CI): 0.791-0.953, P=0.01] and 0.708 (95% CI: 0.614-0.801, P<0.001) for the diagnosis of steatosis ≥ S2 and ≥ S1, respectively. Using LSM, the AUC were 0.588 (95% CI: 0.486-0.691, P=0.10) and 0.651 (95% CI: 0.480-0.822, P=0.10) for the diagnosis of fibrosis ≥ F2 and F3-F4, respectively. Cut-offs for CAP were 246.5 dB/m for S1 and 275.5 dB/m for S2. Cut-offs for LSM were 7.65 kPa for ≥ F2 and 9.25 kPa for ≥ F3.
TE may be useful for screening advanced fibrosis and, interestingly, steatosis after LT. TE might gain relevance to track graft metabolic dysfunction and to propose lifestyle interventions.
移植肝脂肪变性和纤维化的检测对于避免移植肝失功是一项挑战。随着非侵入性检测方法的出现，肝移植（LT）后肝活检（LB）的作用正在发生变化。我们的目的是评估瞬时弹性成像（TE）预测LT后脂肪变性和纤维化的准确性。
对158例LT患者进行了这项前瞻性研究。在LB之前进行受控衰减参数（CAP）和肝脏硬度测量（LSM）。我们绘制了受试者工作特征（ROC）曲线以评估TE的预测性能。
使用CAP诊断脂肪变性≥S2和≥S1时，曲线下面积（AUC）分别为0.872 [95%置信区间（CI）：0.791-0.953，P = 0.01]和0.708（95%CI：0.614-0.801，P<0.001）。使用LSM诊断纤维化≥F2和F3-F4时，AUC分别为0.588（95%CI：0.486-0.691，P = 0.10）和0.651（95%CI：0.480-0.822，P = 0.10）。S1的CAP临界值为246.5 dB/m，S2为275.5 dB/m。≥F2的LSM临界值为7.65 kPa，≥F3为9.25 kPa。
TE可能有助于筛查LT后的晚期纤维化，有趣的是，也有助于筛查脂肪变性。TE可能在追踪移植肝代谢功能障碍和提出生活方式干预方面具有重要意义。
